Neuropsychology measures the effects of brain injury, brain disease, and psychiatric disorders on a person’s ability to think. Such an evaluation uses multiple sources of information — medical, occupational, and educational records, clinical diagnostic interview, and standardized measures of cognition and emotion – to develop a cohesive and objective picture of how someone’s brain is functioning and whether or not they are experiencing problems relative to a person of their age, education, and occupational background.

Neuropsychological tests include measures of

i. Attention paying and thought processing speed
ii. New learning and short-term memory for verbal and visual information
iii. Intelligence
iv. Problem solving, judgment, reasoning, and other “executive” functions
v. Communication, both expressive and receptive
vi. Emotional state

Neuropsychological tests are selected by a licensed psychologist holding a doctorate (Ph.D., Psy.D., or Ed.D.) degree, usually with supervised postdoctoral training and, increasingly, with board certification in clinical neuropsychology (ABPP-CN or similar).

The tests themselves may be administered and scored by a neuropsychologist or by a testing assistant (psychometrist) who has been specifically trained in the proper administration and scoring procedures for these tests. Prior to COVID pandemic, nearly all neuropsychological evaluation was conducted face to face. However, pandemic risks of infection have shifted a number of evaluations to being administered virtually (patient at home or in a facility, tester in office) or in a hybrid fashion (patient in the office and tester in separate office).

In virtual or hybrid administrations, testing relies on a high speed audiovisual link, such as Zoom, with presentation of testing materials being controlled by the tester. However, few homes or facilities are adequately equipped to allow for computerized tests to be administered correctly and for the tester to have sufficient control of the test materials. And, even in situations that might be so equipped, few have the necessary computer screen size, lighting, privacy, and background noise reduction to assure valid testing can occur. However, hybrid testing is a valuable option. It maintains the safety of all parties and, with the proper office setup (large screen viewing, adjustable speaker volume, good control over test materials, good lighting and soundproofing) yields results that are indistinguishable from those obtained through face to face testing.

Once the test results are completed and scored, the neuropsychologist reviews the scoring (if done by a psychometrist), compares each score with the expected score for the background of the patient, and analyzes the patterns of strengths and weaknesses to arrive at conclusions of value in clinical and forensic decision making.

A typical forensic neuropsychological evaluation requires 1-5 hours of record review (depending on the case and sources of information), 1-2 hours of clinical diagnostic interview, 3-5 hours of neuropsychological testing, 1-2 hours of personality evaluation, 1-2 hours of analysis and interpretation, and 1-3 hours of report preparation. Total times typically range from 8 to 15 hours but can be higher if there needs to be comparison to previous evaluations.

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